Professor’s Pearls: Pediatric Surgery
1) A newborn girl is born 4 weeks prematurely with several loops of intestine protruding through a small defect to the right of the umbilicus. The intestine appears thickened and there is an obvious blind-ending loop visible.
2) An infant born at 37 weeks’ gestation requires immediate intubation due to profound respiratory distress. Despite aggressive ventilatory and medical support, he is acidotic with poor perfusion. The abdomen appears scaphoid.
3) A 2-year-old girl presents with abdominal pain and a fever of 38.5°C. She had diarrhea and the “stomach flu” 4 days ago. Over the past 2 days the mother reports that her child has had vomiting and episodes of severe abdominal pain in which she draws up her legs onto her abdomen. Between episodes the patient is listless and lethargic. She has had several bowel movements containing blood mixed with mucus. On examination the abdomen is moderately distended and tender on the right side but with no evidence of peritonitis.
4) A 9-month-old male who had been born 1 month early has been increasingly irritable over the past 4 hours and is found to have right-sided groin and scrotal swelling. The parents report one episode of nonbilious vomiting. The child is in obvious distress. The abdomen is mildly distended but not tender. There is a firm, tender mass extending from the right groin into the scrotum.
5) A 2-year-old boy is brought to the ED with massive lower GI bleeding. He has not had any abdominal discomfort and has previously been well. On examination he is pale and hypotensive with maroon blood on digital rectal examination.
What is the most important consideration in initially treating this patient? What is the most likely dx? What other complications may also arise from this patient’s condition?
6) A 6-week-old infant presents to the ED crying with a report of several episodes of bilious vomiting over the past few hours. He has never had an episode like this before. His abdomen is soft and nondistended but he is in mild distress and crying, with little ability of his parents to console him.
7) A 2-year-old boy is found by his pediatrician to have a right-sided abdominal mass that is hard, smooth, and fixed. His parents have noticed that he has been irritable for the past 2 weeks with unexplained low-grade fevers. His blood pressure is elevated.
8) A 1-month-old infant is noted to be jaundiced. His parents report that his stools have been white. On examination the liver is palpably enlarged and firm. Serum bilirubin (total/direct) is 16/9 mg/dL, AST is 100 IU/L, ALT is 120 IU/L, and GGT is 200 IU/L.
What are the diagnostic possibilities? What further studies are indicated?
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